BACKGROUNDS: Tattooing is an atavist and diffuse phenomenon of interest to various areas of knowledge. Its practice by specific groups such as prisoners and psychiatric patients has turned it into a stigma.OBJECTIVES: To investigate the discourse of tattooed individuals about the discrimination and the construction of stigmas resulting from marks in the body.METHODS: 42 individuals were interviewed and the data were analyzed.RESULTS: The profile of the participants was as follows: most were women; with 2 to 4 tattoos; who were about 23 years old when they got their first tattoo; with an undergraduate degree; who viewed tattooing as a trend; who did not report any important fact that made them get a tattoo; who classified the pain of getting a tattoo as tolerable, who stated that never felt discriminated and never felt the need to hide the tattoos; who find that tattoos make them more sexually attractive; who do not view tattooing as a form of cultural resistance; who said they would not have done it if they believed it caused them professional problems; who stated that they were not drunk when they got the tattoos; who said they were not habitual drugs users, who believed that tattooing is a form of expression and aesthetic sense.CONCLUSION: A difference between the discourse of tattooed individuals and their acts was observed in relation to the social context. In addition, there has been an important shift in the meaning of the practice to tattooed individuals.

Keywords: Prejudice; Skin; Tattooing

INTRODUCTION

The practice of skin ornamentation is certainly as widespread and ancient as man himself. It has been found in mummies from the period of 2,000 to 4,000 AC. Its origin is unknown. Some authors believe that it may have appeared in various parts of the world independently; others think that major sea voyages from European countries disseminated it worldwide. 1

The present study aims at investigating the topic of tattooing due to the fact that the number of tattooed individuals has been growing considerably. This investigation is relevant due to the many implications of the topic. We seek to understand the participants' reasons to get a tattoo and their perceptions about the inscription of permanent marks on the skin. Based on these issues, the present study investigates the discorse of tattooed individuals, their personal history, knowledge about and experiences with the topic. Their perception about tattoos in our modern society is also considered. It is difficult to obtain these answers due to the lack of studies conducted in an ordinary environment, outside of prisons, psychiatric asylums, and rehabilitation centers, where it is easier to find a troubling relationship between tattooing and specific anti-social lifestyles.

The term tattoo comes from the Tahitian word "tau"2 or "tatau"3, which means "open wound, punctured drawing". It is an onomatopoeia in reference to the sound produced by the tool used to knock on a bare-tree trunk. 2

The English term tattoo was introduced by the English Explorer James Cook, in July of 1769, when he returned to Europe. 4 Later, it was translated into other languages: tattowierung, in German; tattuaggio, in Italian; tatouage, in French; tattooing, in modern English; and tatuagem, in Portuguese.2

Currently, tattoos are made with pigments, mainly of mineral origin, and with specific tattoo needles. Needles and inks should always be disposable and never reused (even if by the same person). 5 Machines should preferably have a surgical stainless steel and/or disposable point; they should be cleaned by ultrasound and sterilized in a heater at a temperature equal to or higher than 170 ºC, for a period of at least three hours. 5

According to Marques, the correct technique for tattooing is the needle to perforate the skin and deposit pigment into it. When the needle comes out, the skin's own elasticity holds the pigment inside.

There is still no federal legislation in our country that regulates the practice of tattooing. However, various bills of law are under discussion.

The medical problems associated with the use of tattoos should be considered. There is documented scientific evidence about the association of various infectious diseases with tattoos. 6 The main risks are the transmission of hepatitis B (HBV), hepatitis C (HCV) and the Human Immunodeficiency Virus (HIV). 7 It is known that, in case of an infected needle, the likelihood of transmission is 16% for hepatitis B, 12% for hepatitis C, and 0.5% for HIV. 7

A research study conducted by Nishioka and Gyorkos with 345 individuals found HBV in 15.4% of them, HCV in 9.9%, HIV in 8.4%, syphilis in 5%, and Chagas disease in 2.9%. Prevalence was higher in relation to the control group, except for Chagas disease. 6

Another risk to be considered refers to the dyes used. They have different origins and no control or consistency. It is believed that up to 17% of the 52 dyes identified in the market contain cancerous substances. 8

There are reports of allergic reactions to the dyes used 9,10 and of reactions when the tattoo is removed. 11 Breakage of pigment particles generates decomposing products, which are toxic or even cancerous.12

Since the appearance of tattoos, there is also the concern with their removal. Throughout the past 100 years, chemical and physical methods have been employed without success. 13 Later, the skin was sanded until the dermis was reached. The two alternatives left an unpleasant and permanent scar.

Data are available about individuals who regret getting a tattoo. Studies report that about 10% of tattooed subjects decide to have their drawings removed. 12 A research conducted by Armstrong et al. reveals that adolescents who impulsively get a tattoo regret doing it years later. 14 In the same study, 75% of those who regretted getting a tattoo were 12 to 19 years old when they did it; 38% felt they were being "rebellious" when they decided to get a tattoo, but 32% did not felt this way. In a study by Varma and Lanigan, in 48% of the cases the main reason for tattoo removal was the desire to improve one's selfesteem; 24% wanted to remove a tattoo that was socially stigmatizing and that they thought made them less credible; 13% removed their tattoos due to family pressure; 12%, due to job requirements, and 3%, for other reasons. 15

The tattoos remained in their bodies for an average of 14 years (from 2 months to 48 years), 15 the same average found in the study by Armstrong et al. in 60% of the cases. In the same study, 22% had gotten their tattoo at least five years before and 11%, one year or less. 14

The association of tattoos with criminals is still present in the 21st century, expressed in the words by França in the book (2001) titled Legal Medicine. In its sixth edition (p. 50), the book brings the following statement: " The importance of tattoos is even greater because some of them are found in those who lead an idle and marginalized life and in reincident criminals; however, in our environment, the high society practices body modification (tattooing) for charm and fashion (Figure 1) 16,17.

It is estimated that today 30 to 35% of male individuals in the jail population have some kind of permanent drawing in their bodies. These drawings identify, through codes and prison secrets, the crime committed by the prisoner who has that particular tattoo. 15,17,18

A habit that has been associated with the use of tattoos is alcohol consumption. A study by Stephens with 1800 tattooed individuals showed that 18% were under the influence of alcohol when they got their tattoos. This study also showed an association between tattoos, tobacco and alcohol use. 19 Some authors clearly associate tattooing with psychopathology, such as Raspa and Cusack1 and Fergunson-Rayport; Griffith and Straus.

MATERIAL AND METHODS

This research is part of a Master's dissertation defended in the Criminal Sciences Program at PUCRS. It is a descriptive, non-controlled, transversal study with a mixed approach, where qualitative and quantitative data of the population studied were investigated. Data collection was done through individual structured interviews, with open and closed questions.

After approval of the research project by the Ethics Research Committee of PUCRS, data from the interviews were analyzed, totaling 42 tattooed individuals. Both men and women, aged from 18 to 65 years, participated in the research.

A control-group was not included in the study since the objective of this work was to investigate the perception that tattooed individuals have of their own tattoos and of tattoos in general.

The Statistical Package for the Social Sciences, version 11.5 was used for the statistical analysis of the data. A descriptive analysis of the sample (frequency, mean, mode, median, percentile) was conducted. Open and closed questions were codified and categorized and later submitted to quantitative analysis. Pearson's linear correlation, also called productmoment correlation coefficient, of the SPSS program was employed. The analysis was conducted individually and later assumed to represent the entire group.

RESULTS

Forty-two individuals were interviewed; 31 (73.80%) were women and 11 (26.20%) were men.

Answers varied considerably regarding the meaning of their first tattoo. For a better analysis, we grouped the answers in categories, as shown in the figure below.

The pain was described as minimal, mild or bearable by 78.1% of the participants.

97.6% of the participants knew it was difficult to remove a tattoo; 51.2% considered tattooing fashionable when they got their first tattoo; 81% of the interviewees had tattooed friends and 97.6% still had them at the time of the interview.

For 64.3% of the individuals their tattoos make them more sexually attractive. 38.41% think that it would be normal to have a tattooed partner; 40.5% believe it would be good or wonderful to have a tattooed partner; 72.5% think tattooing is not a form of cultural resistance.

The opinion of others about tattoos is not important to 71.8% of the interviewees. 85.4% of the participants think that their partner's opinion does not prevent them from getting a tatttoo; 64.9% of the individuals said their families liked their tattoos. The reaction of friends was described as positive in more than 80% of the cases. 42.4% of the interviewees ignored the opinion of their coworkers, 24.2% were indifferent to it, 3% referred to it as bad and 30.3% considered it good. 83.3% of the participants revealed they would not get a tattoo if it caused them professional distress.

92.9% affirmed they did not feel discrimated against. However, 40.5% said they have hidden their tattoo before. Only 7.1% of the interviewees reported having thought about removing their tattoo.

Pearson's correlation analysis showed that patients with more tattoos experienced less pain. In addition, an inverse relationship was found between the number of tattoos and piercings (the higher the number of tattoos, the smaller the number of piercings). The whole group perceived tattooing as fashionable. There was a moderate, highly significant (p=0.006, r2 = 0.42). correlation between the variables a) whether interviewees thought about getting other tattoos and b) the affirmative that tattooing is the result of a society obscessed with body and beauty.

There was a moderate, highly significant (p =0.001, r2 = 0.48) correlation between the variables a) whether individuals thought about getting other tattoos, and b) the affirmative that tattooing is the result of media-projected images.

There was a low, inverse, and significant correlation ((p =0.034, r2 = -0.328) between the variables a) level of education and b) whether something remarkable had influenced their decision to get a tattoo. In other words, the lower the level of education, the greater the chance of something influencing their decision.

Individuals were less likely to give up on the idea of getting a tattoo - even if it couse cause them professional harm - if they believed that tattooing was a form of becoming prettier.

There was a moderate, highly significant correlation (p =0.005, r2 = 0.42) between the variables a) the affirmative that tattoing is a form of reversing the signs of aging and b) the affirmative that tattoing is a form of disguising something they do not like about themselves.

There was a high, very significant correlation (p =0.000, r2 = 0.70) between the variables a) the affirmative that tattoing is the result of mediaprojected images and b) the affirmative that tattoing is the result of a society obssessed with body and beauty.

In this sample, the variables studied were not influenced by gender.

The same applies to the questions 1) do you think that tattoos can make you more sexually attractive?, 2) Is the opinion of other people about tattoos relevant?, and 3) Do you think that tattooing can be a form of cultural resistance? No association was found.

DISCUSSION

Women, with incomplete and complete higher education (78.6%), predominated in the sample (73.8%). We observed that the higher the educational level, the smaller the number of tattoos.

This study showed that, in most cases, no remarkable reason or fact influenced the decision of getting a tattoo (64.3%). Generally, the interviewees believed that tattooing was a form of becoming prettier and of expressiong themselves. The research by Armstrong et al., 14 did not reveal specific motivations for the act. In our sample tattooing was viewed as a form of disguising some physical sign they did not like about themselves, such as signs of aging.

Studies show an association between impulsiveness to get a tattoo and regret. 20 Most individuals in our sample waited more than a year to actually get a tattoo (42.9%), showing that impulsiveness was lower in this sample. The age average of the group when they got a tattoo was 23 years old, a bit higher than what is found in the literature, which varies from 14 to 48 years old.

About 64% of the interviewees believe that tattoos can make them more attractive and 78.6% think it would be normal or wonderful to have a tattooed partner; 52.4% of the participants state that having a tattoo is different for men and women.

A particular aspect, often explored in the literature, is the association between alcohol use and tattooing. This association was not found in our study; none of the interviewees gave a positive answer to this question. However, participants may not have admitted to having used alcohol. This denial is common in studies about the use of drugs and other behaviors and habits perceived as socially inadequate. 20

Another interesting aspect is pain tolerance. It is known that identification with an activity or group makes it possible to perform rituals with pleasure.

Pain was classified as tolerable by 53.7% of the participants and as minimal or mild by 24.4%. It is interesting to note that 12.2% stated that the pain was good, great or even addictive. This last group is mainly constituted by individuals with more than one tattoo. We may conclude several things based on these results, such as: these individuals have more tolerance to pain; they feel more in tune with the context of tattooing; as some of them described, they are addicted to tattooing and everything involved in this practice.

Reports about the influence of the media on the use of tattoos were not found in the literature. Nevertheless, participants in our sample said that the media may play a role. Interviewees who said they wanted to get other tatttoos agreed with the affirmative that tattooing is the result of mediaprojected images. We convey that the media and fashion influenced the behavior of the individuals who participated in this research.

Even though they did not feel discriminated against, most participants stated that they would not get a tattoo if it caused them any professional harm. We may conclude, based on the interpretation of the data, that if interviewees believed that tattoing was a form of becoming prettier, they were less likely to give up on the idea of getting a tattoo, even if it caused them professional harm.

Approximately 61% affirmed that when they got their first tattoo, they were thinking of getting others, and 64.3% actually got them.

64.9% of the participants reported that their families approved their decision; 3.7% said they heard complaints or that they had disappointed their families; 31.7% stated that their families had acted surprised or found their decision strange. We observed a greater tolerance by family members and this possibly reflects higher acceptance as a consequence of the increase of the practice over the last decades.

CONCLUSION

Tattooing is an atavic and diffuse phenomenon of interest to various areas of knowledge, such as Medicine, Psychiatry, Dermatology, Law, Psychology, and Anthropology.

Its practice by specific groups such as prisoners and psychiatric patients has led to its stigmatization throughout history.

Therefore, this work aimed at investigating the discourse of tattooed individuals and their perceptions about several aspects related to the topic, with emphasis on the perception of discrimination. The main results of the Field research, based on the analysis of the 42 interviews, indicated when evaluated in conjunction that there is still some kind of stigmatization of tattooed individuals; however, we observed that they do not perceive or even deny this reality.

The contradiction was expressed by the participants in the objective questions associoated with discrimination and other more general questions, and in those in reference to the production of the tattoo - such as area of the body, for instance. We can note that there is a difference between the discourse of tattooed individuals and their actions, in relation to the social context.

In our study an important change in the meaning of the practice was observed. Even if a few describe tattooing as an act of rebellion, most participants recognized the production of an embellishment, a form of expression, as reasons to get a tattoo.

Considerations also point to the urgent need of a specific national legislation to regulate the instruction of tattooers, the operational conditions of tattooing studios, and the origin of dyes and other materials used. Research on the possible risks involved in the removal of pigments through medical techniques, such as lasers, should also be conducted.

Future studies are suggested in which the application of a questionnaire with more specific questions on the knowledge of tattooed individuals about possible health risks, such as the prevalence of associated infectious and psychiatric diseases, and about tattoo removal. Another suggestion is a more random, larger sample including individuals from other social groups.

By drawing the profile of tattooed individuals in a non-institutionalized group like prisoners and psychiatric patients, this work attempted to contribute to the debate about the various issues that involve the practice of tattooing, seeking to demystify the stigma historically associated with this group.